Images in Clinical Medicine

Bronchial Obstruction after Pneumonectomy

Loren J. Harris, M.D.

N Engl J Med 2009; 361:1688October 22, 2009

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Article

A 42-year-old woman underwent right pneumonectomy because of extensive parenchymal destruction due to tuberculosis. Five years after resection, she reported increasing shortness of breath, wheezing, and dyspnea on exertion. A computed tomographic scan of the chest revealed counterclockwise rotation of the mediastinum, with mediastinal shift and compression of the left-lower-lobe bronchus (LLLB) between the pulmonary artery and aorta (Panel A, arrow), features consistent with the post-pneumonectomy syndrome. Mediastinal repositioning was accomplished with the use of an intrapleural-tissue expander and saline-filled prosthesis. Panel B shows a patent left-lower-lobe bronchus (asterisk) and the saline-filled prosthesis in the right side of the chest (arrow). Intraoperative bronchoscopy shows the left-lower-lobe obstruction before treatment (Panel C; LULB denotes left-upper-lobe bronchus) and resolution of the obstruction after treatment (Panel D). Postoperatively, the patient's symptoms resolved completely.

Loren J. Harris, M.D.
Beth Israel Medical Center, New York, NY